In the 113th Congress, about three-quarters (15) of the 19 doctors in the House and Senate are Republicans. Of these, about three-quarters (11) belong to the Surgical Specialities. What's more, almost all of them come from the worst performing states for healthcare identified by a recent report from the Commonwealth Fund.
In 2009, Mayo Clinic polled 2000 MDs on their political views and their views on health care reform: NEJM (2009): Mayo Clinic Poll: Physicians' Beliefs and U.S. Health Care Reform.
A key finding was that "surgeons, procedural specialists, and those in nonclinical specialties were all significantly less likely than primary care providers to favor reform that expands access to basic health care by reducing reimbursement for expensive drugs and procedures"
Join me below the squiggle for a list of doctors in Congress, state health care rankings and maps showing where in the United States you really, really don't want to get sick.
Of the 11 GOP legislators in the surgical specialties, all but one (our dear Rand Paul) belong to specialties that are "most sued": cardiovascular surgery, orthopedic surgery, general surgery, gastroenterology and OB/Gyne (I'm not including non-MDs).
Republican MDs in House & Senate, 113th Congress
A
report by the Commonwealth Fund last September indicated that 86,000 deaths a year would be avoided if "some states" improved their health systems.
Commonwealth Fund Report: State Ranking
This analysis is based on the disparities in the quality of care for low income populations, a factor apart from whether Medicaid is expanded, which deals with access to care.
Our group of GOP MDs serving in Congress all just happen to hail from the 12 worst performing states in the Commonwealth Fund report. Add poor performance to continued lack of access and no wonder Commonwealth's map of overall health system performance looks like this:
Commonwealth Fund: Overall Health System Performance
As the Institute for Southern Studies
reported In 2009, "some of the biggest opponents of health reform in Congress come from districts – such as ones in Texas and Florida – with the highest rates of uninsured residents." And among these, there has been a concentrated group of outspoken physicians: Tom Coburn from Oklahoma, Rand Paul from Kentucky, & Phil Gingrey from Georgia, to name a few.
There are incentives in the Affordable Care Act that would change the power relationship between surgeons and internal medicine physicians (or "internists"). Based broadly on the group practice model, "accountable care organizations" or ACOs, aim to move the health care system toward a collaborative model orchestrated by a primary provider, most commonly, an internist.
ACOs give more power in decision making to internists. Written into the ACA, ACOs are also being tried for Medicare. These changes to the delivery model, now gaining a foothold in some blue states, should help to normalize clinical practice across the country to conform to the high quality, low cost models of New England, the Upper Midwest & Mountain West as opposed to the specialist-driven low quality, high cost models of the Southeast and Texas. They would alter forever the power relationship between Dem-leaning internists and GOP-leaning surgeons.
Dartmouth Atlas: Differences in costs to Medicare for rural care.
Now you may have an idea of why so many of the MDs in Congress are crying "The Sky Is Falling!" if Obamacare succeeds. For many of them, it could.